An Overview of Abortion in the United States. Guttmacher Institute January 2014

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1 An Overview of Abortion in the United States Guttmacher Institute January 2014

2 Objectives Provide an overview of unintended pregnancy and abortion in the United States. Review the incidence of pregnancy and abortion. Discuss provision of and access to abortion services. Review the safety of abortion. Identify who has abortions, why and when in pregnancy. Provide a comparative international perspective on abortion.

3 Incidence of Unintended Pregnancy and Abortion

4 Pregnancies in the United States (Approximately 6.6 Million in 2008) % of pregnancies Intended Unintended

5 Outcomes of Unintended Pregnancies (Approximately 3.4 Million in 2008) % of unintended pregnancies (excluding miscarriages)

6 Incidence of Abortion In 2011, some 1.06 million pregnancies were terminated by abortion in the United States. The abortion rate in 2011 was 16.9 abortions per 1,000 women aged Put differently, 1.7% of all women aged had an abortion in 2011.

7 In 2011, U.S. Abortion Rates Reached Their Lowest Level Since 1973 Abortions per 1,000 women

8 Abortion Service Providers

9 The Number of Abortion Providers Has Declined Substantially, Mainly Due to Fewer Hospitals Providing Abortion No. of providers

10 The Overwhelming Majority of Abortions Are Performed in Clinics % of abortions

11 Facilities Providing Only Medication Abortion Had a Significant Impact A minimum of 193 nonhospital providers, or 17%, offered only early medication abortion in 2011; most were nonspecialized clinics or physicians offices with small abortion caseloads. The provision of medication abortion, particularly by providers who do not offer surgical abortion, is likely responsible for the stabilization in the number of abortion providers that has occurred since 2000.

12 Percentage of Providers of 400 or More Abortions per Year Who Reported Harassment in 2008 Picketing 88% Picketing with physical contact with patients 37% Vandalism 19% Picketing homes of staff members 7% Bomb threats 5% Patient pictures posted on the Internet 5%

13 Gestational Age

14 Abortions Overwhelmingly Occur Early in Pregnancy % of abortions Weeks

15 Incidence of Early Medication Abortion, 2011 Early medication abortion accounted for 23% (239,400) of all nonhospital abortions, an increase from 17% in An estimated 36% of eligible abortions (those performed up to nine weeks) were early medication abortions. Fifty-nine percent of all known providers offer this service, compared with 33% in early 2001.* *Mifepristone was approved by the U.S. Food and Drug Administration for use in early medication abortion in September 2000.

16 Early medication abortion as a percentage of all abortions Number of abortions, in millions

17 Safety of Abortion

18 Long-Term Safety of Abortion First-trimester abortions pose virtually no risk of Infertility Ectopic pregnancy Miscarriage Birth defect Preterm delivery or low birth weight Abortion is not associated with breast cancer. Abortion does not pose a hazard to women s mental health.

19 Abortion Is Safer the Earlier in Pregnancy It Is Performed Deaths per 100,000 abortions Gestation at abortion

20 Deaths Associated with Abortion Declined Dramatically After Legalization

21 Causes of Abortion-Related Deaths % of deaths

22 Who Has Abortions

23 Unintended Pregnancy Rates Have Risen Among Poor Women Even As They Have Fallen Among Higher Income Women 160 Unintended pregnancy rate (per 1,000 women 15 44) All women <100% of poverty % of poverty 200% of poverty

24 Poor Women Account for a Disproportionate Share of Unintended Pregnancies Women at risk of unintended pregnancy Unintended pregnancies by women s poverty status

25 Poor Women Are Also Overrepresented Among Abortion Patients

26 Black Women Account for a Disproportionate Share of Unintended Pregnancies Women at risk of unintended pregnancy Unintended pregnancies by women s racial status

27 Hispanic Women Also Account for a Disproportionate Share of Unintended Pregnancies Hispanic 19% Hispanic 26% Women at risk of unintended pregnancy Unintended pregnancies by women s ethnic status

28 And Both Groups Are Overrepresented Among Abortion Patients

29 Women in Their 20s Make Up the Majority of Abortion Patients

30 Nearly Half of Abortions Are Obtained by Never-Married Women

31 Most Women Obtaining Abortions Report a Religious Affiliation

32 Six in 10 Women Having Abortions Are Already Mothers

33 Reasons for Abortions

34 Most Important Reasons Given for Terminating an Unwanted Pregnancy Concern for/responsibility to other individuals 74% Cannot afford a baby now 73% A baby would interfere with school/ employment/ability to care for dependents 69% Would be a single parent/ having relationship problems 48% Has completed childbearing 38%

35 Reasons for Abortions After 16 Weeks Since Last Menstrual Period Did not recognize the pregnancy 71% Had difficulty making arrangements for abortion 48% Was afraid to tell parents or partner 33% Needed time to make decision 24% Hoped relationship would change 8% Was pressured not to have abortion 8% Something changed during pregnancy 6% Did not know timing was important 6% Did not know abortion was an option 5% Fetal abnormality was diagnosed late 2% Other 11%

36 Barriers to Abortion Access

37 Many U.S. Counties Lack an Abortion Provider; About 1/3 of Women Live in Those Counties

38 Most Abortion Patients Have Health Coverage

39 But Most Pay Out of Pocket for Abortion

40 More Abortion Restrictions Were Enacted in Than in the Entire Previous Decade

41 In 2000, 13 States Were Considered Hostile to Abortion Rights Supportive Middle-ground Hostile

42 In 2013, 27 States Were Considered Hostile to Abortion Rights Supportive Middle-ground Hostile

43 International Perspective on Abortion

44 The Global Decline in the Abortion Rate Has Stalled Abortions per 1,000 women aged World Developing countries Developed countries

45 Highly Restrictive Abortion Laws Are Not Associated with Lower Abortion Rates The abortion rate is 29 per 1,000 women of childbearing age in Africa and 32 in Latin America, regions where abortion is illegal under most circumstances. The rate is 12 per 1,000 in Western Europe, where abortion is generally permitted on broad grounds.

46 An Increasing Proportion of Abortions Are Unsafe % of abortions that are unsafe

47 21.6 Million Unsafe Abortions Occur Each Year Annual abortions per 1,000 women aged World Developed countries Developing countries Safe abortions Unsafe abortions

48 Virtually All Abortions in Africa and Latin America Are Unsafe % of abortions

49 Consequences of Unsafe Abortion Complications from unsafe abortion procedures account for 13% of all maternal deaths, or 47,000 per year. 8.5 million women experience complications that require medical attention each year; 3 million do not receive care. Virtually all of these deaths and injuries occur in the developing world.

50 Law Reforms in Developing Countries Have Been Followed by Declines in Morbidity and Mortality South Africa (1997): annual number of abortionrelated deaths decreased by 91% after the law was liberalized. Nepal (2002): abortion-related complications as a proportion of all of maternal illnesses (in facilities in eight districts) decreased by 48%. Ethiopia (2005): abortion complications per 100,000 live births (one large hospital) decreased by about 70%.

51 Summary Points

52 Incidence of Pregnancy and Abortion in the United States Unintended pregnancy and abortion are common among all groups of women. Certain groups of women are at greater risk of unintended pregnancy than are others. Half of all pregnancies are unintended. Four in 10 unintended pregnancies end in abortion.

53 Provision of and Access to Abortion Services Most abortions occur in abortion clinics. Many women have to travel significant distances to find a provider, which can pose problems for those with limited resources, or work or family responsibilities.

54 Safety of Abortion Abortion is one of the safest common surgical procedures for women in the United States. Abortion is safe over the long term and carries little or no risk of fertility-related problems, cancer or psychological illnesses. Laws criminalizing abortion make abortions unsafe, but do not eliminate them.

55 Who Has Abortions, Why and When in Pregnancy Disadvantaged women bear a disproportionate burden of unintended pregnancies and abortions. The most frequent reasons women give are that having a child or another child would limit their ability to meet current responsibilities and that they cannot afford a child at this point in their lives. Almost 90% of abortions occur in the first trimester.

56 Obstacles to Obtaining Abortion Services Although most women obtain abortions early in pregnancy, some women face substantial obstacles to access. Nearly four in 10 women of reproductive age receive coverage under Medicaid, yet 32 states allow Medicaid funding for abortion only in cases of rape, incest or life endangerment. Lacking insurance coverage, poor women often require time to find the money to pay for an abortion, if they are able to at all. More than 200 state abortion restrictions were enacted between 2011 and 2013, making it more difficult for women to obtain timely services.

57 International Perspective on Abortion A very small proportion of abortions worldwide take place in the United States. Most unsafe abortions occur in countries where abortion is illegal.

58 About Guttmacher The Guttmacher Institute is a nonprofit organization that advances sexual and reproductive health worldwide through research, policy analysis and public education. For more information about Guttmacher, please click here. Read our report Abortion in Women s Lives here.

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